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GR-67853 (7-14) Page 1 of 4 Evidence of Insurability Statement Life and Disability Coverage Aetna Life Insurance Company Read This Instruction Page Carefully.

How to fill out evidence of insurability statement

How to fill out evidence of insurability statement:

1. Gather the necessary information: Before filling out the evidence of insurability statement, gather all the relevant information, including your personal details, medical history, and any other requested documentation.
2. Read the instructions carefully: It's essential to understand the instructions provided with the evidence of insurability statement. Pay close attention to the specific requirements and any additional documentation that may be needed.
3. Provide personal and contact information: Start by filling out your personal information, such as your full name, date of birth, social security number, and contact details. Ensure accuracy and double-check your information before submitting.
4. Disclose your medical history: Answer all the questions related to your medical history truthfully and thoroughly. Include any pre-existing conditions, surgeries, medications, or treatments you have undergone. Provide detailed explanations when necessary.
5. Fill out any additional sections: Depending on your insurer's requirements, there might be additional sections to complete on the evidence of insurability statement. These sections can include lifestyle choices such as smoking, alcohol consumption, or participation in hazardous activities.
6. Attach supporting documents: If requested, attach any supporting documents that validate the information provided in the evidence of insurability statement. These can include medical records, test results, or other relevant documentation.
7. Review and sign: Before submitting the form, carefully review all the information you have provided. Ensure accuracy and completeness. Once satisfied, sign the form according to the instructions provided.
8. Submit the form: After completing all the necessary steps, submit the evidence of insurability statement to the designated recipient. Follow any additional instructions provided, such as mailing or submitting the form online.

Who needs evidence of insurability statement?

1. Insurance applicants: Individuals applying for life insurance, disability insurance, or any other forms of insurance coverage that require proof of insurability will typically need to provide an evidence of insurability statement.
2. Employees: Some employers may require their employees to complete an evidence of insurability statement when enrolling in voluntary group insurance plans or when making certain coverage changes.
3. Current policyholders: In some cases, policyholders who wish to increase their coverage amount or add additional coverage may be asked to provide an evidence of insurability statement.
4. Dependent coverage: When adding dependents, such as spouse or children, to an insurance policy, an evidence of insurability statement may be required to ensure coverage eligibility.

Please note that the specific requirements for evidence of insurability statements can vary depending on the insurance company and the type of insurance being applied for. It is always advisable to consult with your insurance provider or agent for precise instructions specific to your situation.

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